Download MBBS Extrahepatic Biliary Apparatus Lecture PPT

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INTRAHEPATIC

BILIARY SYSTEM

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NOT

OUR BUISNESS

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EXTRAHEPATIC BILIARY APPARATUS

Consists of :

1. Rt. hepatic duct

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2. Lt. hepatic duct

3. Com. hepatic duct

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4. Cystic duct

5. Com. Bile duct

6. Gallbladder

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HEPATIC DUCTS

? Emerge from

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porta hepatis

? Rt. & Lt. HDs

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unite to form

Common Hepatic

Duct(CHD)

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? CHD =4 cm

? CHD descend in

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lesser omentum

? Joined by cystic

duct to form CBD

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GALL BLADDER

Pear shape

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?7-10 cm in length

?Up to 50 Ml

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?In the gallbladder

fossa on the visceral

surface of the liver

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Gall Bladder(Parts)

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?Fundus

?Body

?Neck

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?Infundibulum

(Hartmann's pouch)

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Surface projection of

fundus: Right linear

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semilunaris// right costal

margin = Murphy's point

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RELATIONS OF

GALLBLADDER:

ANTERIORLY:

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? Ant. Abdominal wall

? Inferior surface of

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liver

POSTERIORLY:

? Transverse colon

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? 1st & 2nd

duodenum

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CYSTIC DUCT

? 3.8 cm

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? Somewhat S shaped

? Its mucous membrane

is forming a spiral fold

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( the spiral valve )


CALOT'S TRIANGLE

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Moynihan's hump

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BLOOD SUPPLY:

?ARTERIAL :

Cystic artery

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? VENOUS :

Cystic vein

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? LYMPHATICS :

A cystic LN at the neck

of GB

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? NERVES :

Autonomic from

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coeliac plexus

Cholecystokinin

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BILE DUCT/COMMON BILE DUCT

? 8cm(3 inch) long &

about 6mm in dia.

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? 1st course (Lesser

Omentum)

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? 2nd course

(behind 2nd Duo.)

? 3rd course ( post.

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To head of

pancreas )

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Blood supply of Bile Duct

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SPHINCTERS
Clinical points:

? Gallstones

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? Biliary colic (epigastric pain, jaundice &

pancreatitis)

? Acute cholecystitis & referred pain to

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shoulder

? Cholecystectomy ( variations )

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? Gangrenous ( single arterial supply )

? Biliary atresia
Imaging of the Biliary Tract

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1. Cholecystography
2. Ultrasound
3. Endoscopic Retrograde

Cholangiopancreatography(ERCP)

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4. Magnetic Resonance

Cholangiopancreatography(MRCP)

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Endoscopic retrograde

Magnetic resonance

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cholangiopancreatography(ERCP)

cholangiopancreatography(MRCP)